Provider Demographics
NPI:1043586993
Name:OSWEGO COUNTY
Entity Type:Organization
Organization Name:OSWEGO COUNTY
Other - Org Name:OSWEGO COUNTY PUBLIC HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-349-3528
Mailing Address - Street 1:70 BUNNER ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3357
Mailing Address - Country:US
Mailing Address - Phone:315-349-3528
Mailing Address - Fax:315-349-3234
Practice Address - Street 1:70 BUNNER ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3357
Practice Address - Country:US
Practice Address - Phone:315-349-3528
Practice Address - Fax:315-349-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3702201R251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474231Medicaid